“Pray I Don’t Alter It Any Further” by Pat Conrad MD


Remember that great exchange in “The Empire Strikes Back” between Lando Calrissian and Darth Vader over the fate of the rebel prisoners?

“LANDO: That was never a condition of our agreement, nor was giving Han to this bounty hunter!

VADER: Perhaps you think you’re being treated unfairly.


VADER: Good. It would be unfortunate if I had to leave a garrison here.
LANDO: (This deal’s getting worse all the time.)

… Later …

LANDO: You said they’d be left in the city under my supervision.

VADER: I am altering the deal. Pray I don’t alter it any further.

It’s an easy analogy to make these days. The enemy of individual choice and autonomy in health care (and anything else) is government aka ‘The Empire.” And because doctors by and large work for government, we are – like Lando Calrissian – corrupted and become our own enemies, surviving by actively working against the interests of our patients and ourselves.

A billing company that I happen to work with gives periodic updates, the latest of which:

– On New Year’s Day 2015, the Centers for Medicare and Medicaid Services will implement “many substantial changes relating to the Physician Quality Reporting System (PQRS) and its impact on reimbursement.”
– The inception of PQRS began in 2007. This system was a Medicare Fee-For-Service reporting system that promised incentive payments “to promote reporting of quality measures performed by eligible health care providers.”

– “It appears the ability to submit PQRS measures via claims may be coming to an end … 2014 is the last year that eligible health care providers can earn an incentive payment for satisfactorily reporting their data on quality measures provided to Medicare beneficiaries. Beginning in 2015, eligible health care providers will receive monetary penalties for not reporting the required PQRS data. This financial penalty will equal 1.5 percent of all Medicare payments during the year.”

For years, King Doug has warned of “quality” as an unproven scam. Likewise I have written a piece or two on government incentive programs – EHR’s, PQRS, medical homes, core measures – being nothing but a shell game. These bastards had it planned from the start to get everyone in the quality-for-pay frame of mind, and then renege on the payout.

Argue all you like, along with the AMA and AAFP, that we need to adapt, to buck up, to be mature, to imagine medical homes, and do the right thing for our patients to make the system work. And like Lando Calrissian, you’ll be lying to yourself, frustrated and impotent when the bounty hunter shows up to audit whether you documented giving Han Solo an aspirin within 5 minute of freezing him in carbonite.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]